A 34-year-old woman with moderate persistent asthma is switched to high-dose inhaled fluticasone. At follow-up she reports white patches in her mouth and throat. Which adjunct measure most directly reduces this complication?
- A Taking the dose immediately before meals
- B Rinsing the mouth and gargling with water after each inhalation ✓
- C Adding a leukotriene receptor antagonist to allow steroid withdrawal
- D Switching from an MDI to a dry powder inhaler
Correct answer: B. Rinsing the mouth and gargling with water after each inhalation
Explanation
Oropharyngeal candidiasis results from local deposition of corticosteroid on pharyngeal mucosa, suppressing local immunity and allowing Candida overgrowth. Rinsing the mouth and gargling after each actuation washes away residual drug and lowers both candidiasis and dysphonia. Spacer devices also help by reducing oropharyngeal impaction. Taking the dose before meals has no effect on deposition, and adding a leukotriene modifier does not address local steroid exposure.
Reference: Katzung's Basic and Clinical Pharmacology, 16th ed.
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Written and medically reviewed by the StethoPrep medical team.